title: An unusual case of proctalgia.
abstract: We report the case of a 21-year-old man with the sudden onset of severe proctalgia followed by headaches and fever. The patient had a lumbar puncture consistent with subarachnoid hemorrhage. After a normal four-vessel cerebral arteriogram, a myelogram and computed tomography scan of the spine were performed and revealed a mass lesion of the L1 level. Pathologic evaluation after resection of the mass resulted in a diagnosis of hemorrhage from a myxopapillary ependymoma. These relatively benign tumors of the cauda equina-filum terminale respond well to treatment. The differential diagnosis of proctalgia is reviewed, and the need for emergency physicians to consider spinal subarachnoid hemorrhage when a patient presents with the acute onset of rectal pain is emphasized.
authors.affiliation: Department of Neurology, George Washington University Medical Center, Washington, DC.
authors.forename: B
authors.initials: B
authors.lastname: Rappaport
authors.forename: H A
authors.initials: HA
authors.lastname: Emsellem
authors.forename: R
authors.initials: R
authors.lastname: Shesser
authors.forename: E
authors.initials: E
authors.lastname: Millstein
mesh_terms: D000328:Adult; D002420:Cauda Equina; D004806:Ependymoma / Q000150:complications / Q000175:diagnosis*; D006801:Humans; D008297:Male; D010146:Pain / Q000209:etiology*; D010524:Peripheral Nervous System Neoplasms / Q000150:complications / Q000175:diagnosis*; D012007:Rectum; D013345:Subarachnoid Hemorrhage / Q000150:complications / Q000175:diagnosis*